LIBERTY, NY — Recent reports have called into question the level of care provided at the Sullivan County Adult Care Center (ACC), as well as the future of the facility and the employees at it. 

A survey conducted on the ACC at the start of the year found consistent understaffing and evidenced the harm such understaffing could create for residents. At the same time, Infinite Care, the management company hired to oversee the facility, has neared an administrative milestone with regard to being able to operate the facility on its own. 

Certificate of need

The status of the ACC is changing because of changes to its certificate of need (CoN). 

A CoN is required for a medical facility, such as a nursing home, to operate. It certifies that a community needs the medical services that the facility provides, and authorizes that facility to meed those needs. 

Sullivan County government currently holds the CoN for the ACC. When it hired Infinite Care to run the ACC, it did so in the understanding that the company would lease and operate the ACC—not just run it—once it had the CoN. 

The transfer of the CoN from Sullivan County to Infinite Care was delayed; according to a November 18, 2021 resolution from the Sullivan County Legislature, New York State had a delay in processing CoN applications. 

An LLC tied to Infinite Care (Sunset SNF Operations LLC) submitted a CoN application “to be established as the new operator” of the ACC, an application received January 31. This application is still under review by the state. 

Comments can be made on the CoN application to CONS@health.ny.gov; the application’s project number is 231044. 

Why this matters

When Sullivan County first hired Infinite Care to consult, that decision followed an attempt by the county to sell the ACC, an attempt that faced significant public pushback and was abandoned. 

Now, advocates for the ACC are concerned that a sale may again be a possibility. 

Some of the language in the CoN application points to the original plan of a lease agreement, with a 20-year term to start upon approval of the CoN application. Other language points to a sale, citing a “Facility Transition Agreement” of January 9, and saying that Sunset SNF Operations LLC will purchase the ACC from Sullivan County, for the price of the “assumption of certain liabilities.” 

“The intent of the Sunset Lake LDC is to enter into a lease agreement with Infinite/Sunset SNF Operations to operate the Care Center,” Sullivan County Director of Communications Dan Hust told the River Reporter. 

Advocates are also concerned at the implications for the ACC’s staff. 

Staff at present are members of the county employees’ union, and continued to be so while the facility was owned by an LDC and leased by Infinite Care. 

When and if the transfer occurs, all staff at the care center will be employed by Sunset SNF Operations, says Hust. “Various existing county employees have already switched to employment with Infinite Care, and more such transfers are anticipated, as Infinite/Sunset offers their own set of benefits. For county employees who don’t wish to switch to private employment, county officials are working to find them positions within other parts of county government, so that they may retain their public employee benefits.”

Safe staffing

Uncertainty about the future of the staff at the ACC is accompanied by inadequacy of the levels of staffing there at present. 

A survey of the ACC conducted from December 27, 2022 to January 5 highlighted issues with its staffing and internal policies. It cited deficiencies in 12 areas, including in qualified dietary staff, resident rights and infection prevention and control. 

A review of staffing levels found that the facility was understaffed on 10 days out of 21 between December 9 and 30, 2022. “Three of four resident care units reviewed for sufficient staff did not consistently have adequate staff to meet the needs of the residents,” the report summed up. 

A lack of staff had an impact on patient care. Nursing staff interviewed told surveyors that there was sometimes no time to bathe residents, and that staff were overwhelmed with making sure medication was administered on time to the point that documentation of tasks went unchecked.